Question of the Week & Rationale 

Our “Question of the Week” is created weekly by Coach Beverly to cover a variety of Diabetes related topics. The questions are designed to keep you current and prepare you for the CDCES® Exam.

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This week’s Rationale: Question of the Week – January 9th – test your knowledge before seeing answer below! 

What a perfect way to information share and bring new concepts to light. We appreciate our community of diabetes educators and the opportunity to keep learning together! 

Question: The 2018 ADA Standards of Care include updates to the Cardiovascular Disease and risk management section. Which of the following accurately reflects updates to this section?

a. All hypertensive patients with diabetes should monitor home blood pressure.

b. The new B/P goal is 130/80 to match the American Heart Association’s goal.

c. All patients with type 1 diabetes should be started on an ACE Inhibitor.

d. Beta blockers should be avoided for all patients on insulin therapy.

Correct Answer:  a. All hypertensive patients with diabetes should monitor home blood pressure.

Rationale: 

CV Disease Risk Management – ADA 2018 Update

After the American Heart Association set a new B/P target of 130/80, the diabetes world held their breath to see if the American Diabetes Association (ADA) would follow suit and lower it’s BP target. 

The ADA maintains the B/P target of 140/90, based on a comprehensive review of studies measuring the cost/benefit of blood pressure control in people with diabetes. They specifically summarized the ACCORD BP trial findings (see below paragraph*).

Current ADA Recommendations are as follows:

Hypertension, defined as a sustained blood pressure more than or equal to 140/90 is a major risk factor for both CV and microvascular complications. Numerous studies demonstrate that antihypertensive therapy reduces CV events, heart failure, and microvascular complications.

Screening and Diagnosis Recommendations

• Blood pressure should be measured at every routine clinical visit. Patients found to have elevated blood pressure (more than or equal to 140/90) should have blood pressure confirmed using multiple readings, including measurements on a separate day, to diagnose hypertension. 
• All hypertensive patients with diabetes should monitor their blood pressure at home.

As far as answers c and d, they are wrong for the following reasons:

1.  The ADA no longer recommends automatically starting people with Type 1 Diabetes on an ACE Inhibitor if there is no hypertension or proteinuria.
2. For patients with diabetes post MI, beta blockers are the B/P medication of choice.  Pts with diabetes on insulin can still experience diaphoresis when hypoglycemic (breakthrough symptom). However, they should be encouraged to check BG on a regular basis and notify provider if BG is running lower than targets.

For more info, see our CV Risk Management Blog Post